what does a CRAO/BRAO indicate what is the life expectancy of someone with a CRAO compared to someone without a CRAO

Life expectancy 5.5 years compared to 15.4 years for age matched population without CRAO

5

what is the clinical presentations of a CRAO/BRAO

Sudden, severe, painless loss vision.

~90% px with CRAO have vision between counting fingers and light perception at presentation.

1-2% bilateral presentation.

Mean age early 60s.

May have history of amaurosis fugax (transient loss of vision lasting seconds-2 hours – vision returns to normal afterwards).

With branch occlusion, extent of visual loss will depend on location of occlusion.

6

what are the 5 signs of an acute CRAO/BRAO

Inner layers of the retina become oedematous and milky/opaque.

Opacity greatest at macula where RNFL and RGC layers thickest.

Ischaemic necrosis results from the disrupted blood supply

Fovea shows a ‘cherry red spot’ because fovea is nourished/being provided for by underlying choroidal circulation so it's not becoming ischaemic, and because retina is thinnest here so underlying choroid seen.

what will be your management of a patient seen with a CRAO/BRAO

In practice can do the following:- Ask px to lie flat (raises pressure in ophthalmic artery)- Ocular massage may help to dislodge the embolus – press on eye with heel of hand (10 sec on, 10 sec off for 5 mins). - Can ask Px to breath into paper bag – increased CO2 levels will cause vasodilation and may help to dislodge the embolus - But best to get them to casualty ASAP!

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why you need to refer a px with CRAO/BRAO due to an emboli and due to arteritic inflammation cause urgently

Patients with CRAO/BRAO due to emboli are at high risk of stroke / heart attack – need urgent referral for medical assessment even if window of opportunity for vision restoration has passed.